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ADHD-Guideline Update Highlights Importance of Addressing Comorbid Conditions

September 30, 2019

By Reuters Staff

NEW YORK—The American Academy of Pediatrics (AAP) has updated its 2011 clinical practice guideline on the evaluation, diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) in children from age four to 18 years old.

National survey data from 2016 indicate that 9.4% of children in the United States ages two to 17 have been diagnosed with ADHD; almost two-thirds were taking medication for ADHD, and about half had received behavioral treatment. Yet, nearly a quarter had received no treatment.

"Since 2011, much research has occurred, and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), has been released. The new research and DSM- 5 do not, however, support dramatic changes to the previous recommendations," the guideline panel writes.

Therefore, the revised guideline includes only "incremental" updates to the previous guideline, they note. One such update is the addition of a key action statement (KAS) stating the importance of diagnosing and treating comorbid conditions in children and adolescents with ADHD.

These include emotional or behavioral conditions (anxiety, depression, oppositional defiant disorder, conduct disorders, substance use), developmental conditions (learning and language disorders, autism spectrum disorders), and physical conditions (such as tics and sleep apnea).

"Evidence is clear with regard to the legitimacy of the diagnosis of ADHD and the appropriate diagnostic criteria and procedures required to establish a diagnosis, identify comorbid conditions, and effectively treat with both psychosocial and pharmacologic interventions. The steps required to sustain appropriate treatments and achieve successful long-term outcomes remain challenging, however," the panel writes.

The revised guideline was published online September 30 in Pediatrics.

The procedures recommended in the guideline require "spending more time with patients and their families, developing a care management system of contacts with school and other community stakeholders, and providing continuous, coordinated care to the patient and his or her family," they note.

The AAP has also published two supplemental documents with the updated guideline. One is a process of care algorithm (PoCA) for the diagnosis and treatment of children and adolescents with ADHD and the other is an article on systemic barriers to the care of children and adolescents with ADHD.

"These supplemental documents are designed to aid primary care clinicians in implementing the formal recommendations for the evaluation, diagnosis, and treatment of children and adolescents with ADHD," the panel says.


Pediatrics 2019.

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